URAC Consulting
Your health care organization is unique. Whether it is an HMO, a PPO, a medical management company, a pharmacy benefit manager, or a health website, there was no cookie-cutter that produced it. Rather, it has evolved over time to meet your clients' needs and fit the particular environment in which you operate.
So, when it comes time to apply for URAC and/or NCQA accreditation, when you are looking for an accreditation consultant to help you, you'll be looking for consultants who have seen the incredible diversity in the health care industry. You'll want deeply experienced professionals who understand how your particular organizational structure, operating procedures, and client mix will fit with URAC's or NCQA's standards.
Experts in URAC and NCQA Accreditation
Integral Healthcare Solution's accreditation consultants have deep experience in the world of accreditation, and particularly with URAC accreditation. Our senior consultants include URAC's former Chief Operating Officer and General Counsel, former Vice President of Accreditation, and former Manager of URAC's HMO, PPO, Credentials Verification Organization and Worker’s Compensation Network accreditation programs. In addition we have a growing stable of veteran NCQA reviewers and consultants who, together, have amassed over 60 years of NCQA consulting and reviewing experience.
Because our clients range from some of the largest health insurers in the U.S. to very small independent review organizations and medical management firms, and include both veteran URAC-accredited companies and first-time applicants, we have designed a scalable range of accreditation preparation consulting services. We offer our clients the following services:
Application Preparation
We would begin by sending the project lead to our client's office for an initial planning session with relevant client staff members. During that session, we would review the accreditation process, establish a tracking table designed to map staff and consultant activities to application-preparation tasks, and agree upon a schedule of activities for both our client's staff and the IHS consulting team. For those clients who prefer, we offer this service telephonically, as well.
Periodic Teleconferences
Between the onset of the engagement and the submission of the application, IHS and our client will conduct periodic teleconferences, as often as needed to guide the preparation of the application and all the attendant documents. These teleconferences will serve as the primary venue for addressing any questions that our client's staff and leadership may have about the interpretation of standards, appropriate edits for documents to be submitted with the application, and preparation for the onsite review.
Policy Review
IHS will review policies and procedures and other documents necessary for submission with the application, to assure compliance with URAC’s and/or NCQA's standards.
Policy Development
For clients that have few or no formal policies and procedures, we can work with you to transform your practices into URAC- and NCQA-ready P&Ps.
Application Assembly
IHS will provide consulting services in connection with the assembly of the application for submission to URAC. We are experts on using AccreditNet, URAC's document submission platform, and can either advise our clients on how bet to submit through that system, or turn the task over to our AccreditNet specialist to do the uploading for our client.
Mock Desktop Review
After our client assembles its application but before it submits it to URAC or NCQA, IHS will conduct a comprehensive mock desktop review. This involves a close reading of all the documents submitted to AccreditNet, along with all the citations and notes submitted with those documents.
Upon completion of the Desktop Review, we will write a Desktop Review Summary that outlines our findings, replete with recommendations for actions our client should take to address any shortcomings we find in the review process. After submission of our Desktop Review Summary to our client, we will have a conference call with key client staff members to review, in detail, our findings and to discuss the action plan for bringing our client’s submission into full compliance with URAC’s standards.
Mock Onsite Review
After submission of the application and before the URAC or NCQA onsite review, IHS will conduct a mock onsite review. This onsite review will serve two purposes: (1) to give our client staff members a realistic preview of the onsite review process and (2) to provide our client staff members with feedback on how to improve its performance during the onsite review.
Day-Before Preparation for Onsite Review
We can come onsite the day before your onsite review to assure that all your documents and the reviewer conference room are in order, ready to show the accreditation reviewer your full preparation. We can also do some last-minute "touch-up" interviews to make sure every member of your staff is fully prepared.
Presence During Onsite Review
We can be onsite during your onsite review to provide live support, should anything unexpected arise during the review. Such support can come in the form of advice or document preparation/amendment.
As an alternative, we can provide this support remotely from our offices. At half the rate of our onsite services, we'll clear our calendar to make sure that we won't be occupied with an other activity should you need to pick up the phone in the middle of your onsite review and ask a question or for help with document revision.
Preparation for URAC's Unannounced Monitoring Onsite Reviews
In 2005, URAC began conducting Monitoring Onsite Reviews. With as little as one day's notice, and no more than five days' notice, URAC reviews are likely to show up on the doorstep of URAC-accredited companies to conduct an onsite review focusing on the most heavily-weighted URAC standards. We help our clients prepare for these onsite reviews both before and after they have received notice that the URAC reviewers are coming.
Specialized Medicare Advantage Module Preparation
URAC is now a "deemed" accreditation organization for Medicare (see our blog entry on this event). This means that health plans and networks can meet many key CMS requirements by adding URAC's new "MA Module" to their Plan or Network review. Not only have we been involved with the Medicare Advantage deeming process since URAC began seeking CMS's recognition, but also have served as consultants to the first health plan to seek MA accreditation, giving us a uniquely deep understanding of these standards and this process.
Staff Training on URAC or NCQA Accreditation Standards
Included in all of our consulting engagements is free training for all your employees using our new, proprietary e-learning system, AccrediTrain. Click here for more details on AccrediTrain.
Customized Accreditation Consulting Services
Of course, we custom-tailor our service offering to the particular needs our client. The broad success of our clients in the URAC accreditation process is a testament to the value of this kind of deep and broad expertise. You can get a sense of this expertise in our Integral Healthcare Solutions blog. We hope you'll subscribe so you can stay up-to-date on developments and interpretations of accreditation standards and review processes.